Biliary diseases in heart transplanted patients: a comparison between cyclosporine a versus tacrolimus-based immunosuppression

Abstract

A cyclosporine (CsA)-based immunosuppression is associated with an increased incidence of cholelithiasis after heart transplantation. It is not known if tacrolimus (Tac) has comparable biliary side effects in humans.We evaluated the incidence of gallbladder sludge and cholelithiasis under Tac-based immunosuppression by ultrasound examinations in 31 cardiac transplants (25 male, 6 female, mean age: 59 ± 11 years). Data were compared to 57 patients (47 male, 10 female, mean age: 58 ± 11 years) who received CsA-based immunosuppression.6 patients receiving Tac and 6 patients receiving CsA had already gallstones prior to transplantation so that finally 25 patients of the Tac group and 51 patients of the CsA group could be evaluated.In the Tac group the incidence of biliary sludge was 4% (1 of 25), of gallstones 28% (7 of 25). In comparison, patients receiving CsA developed biliary sludge in also 4% (2 of 51) and gallstones in 25% (13 of 51). Nine of 42 males in the CsA group (21%) and eight of 20 males in the Tac group (40%) developed either gallstones or sludge (n.s). Six of nine females in the CsA group (67%), but none of five females in the Tac group (0%) developed either gallstones or sludge (p = 0.01).In summary, the incidence of biliary disease in patients with Tac is comparable with CsA-based immunosuppression. We recommend regular sonographical examinations to detect biliary diseases as early as possible. In cases of clinically, laboratory and sonographical signs of cholecystitis cholecystectomy is indicated. It seems that towards lithogenicity female patients benefit more from a Tac-based treatment because the occurrence of gallstones is rare.

Pharmacokinetics of Cyclosporine A in Chinese heart transplant recipients

“…(1,2) The choice of immunosuppressive program directly affects the transplant effect. The main reason is that immunosuppressant produces toxic side effects on multiple organs of the body after transplanting.…”

Gallstones: Environment, Lifestyle and Genes

“…For example octreotide, a somatostatin analogue, has been implicated in gallstone formation via reduced intestinal transit, hence precipitating lithogenic bile salt pool formation by intestinal bacteria [94,95]. Calcineurin inhibitors, namely ciclosporin and tacrolimus, are also reported to cause gallstones by inhibiting the hepatocanalicular bile salt export pump [96,97]. A class of cholesterol-lowering drugs, known as fibrates, may increase the risk of gallstones as a result of increased biliary cholesterol saturation and reduced bile salt synthesis [98].…”

Acute Cholecystitis Is a Common Complication after Allogeneic Stem Cell Transplantation and Is Associated with the Use of Total Parenteral Nutrition

“…In addition to TPN, prior studies have suggested that the use of calcineurin inhibitors is associated with increased rates of gallstones and acute cholecystitis, although this has not been studied specifically in the HSCT population [26,27]. It is possible that the routine administration of calcineurin inhibitors may have contributed to the high rate of cholecystitis observed in our cohort.…”